Inadequate Consent for Circumcision Procedure

A Case Example

The Patient attended the Trust after suffering from a swollen and painful penis for an extended period of time. The Trust advised that the Claimant undergo a Circumcision (surgical removal of the foreskin) in order to address the issue of pain. The Patient was given leaflets which outlined this procedure and the risks associated with the same, however no discussion took place between the Patient and the clinician about these risks.

The main learning points from this review stem from the following events:

1. When the Clinician provided the Patient with the leaflets about the procedure, he did not discuss the risks addressed in the leaflets with the Patient.

2. The Clinician did not discuss the risk of dissatisfaction with cosmetic appearance with the Patient before they underwent the procedure.

Recommendations to Prevent Incident Recurrence and Improve Patient Safety

TMLEP’s recommendations to reduce recurrence and enhance patient safety are as follows:

1. In a post-Montgomery world, Clinicians need to ensure that they discuss all material risks with a patient when consenting them for a procedure.

Prior to Montgomery, it could be seen as acceptable to simply give a patient a leaflet which outlined the risks of the procedure that they were being consented for. However, in light of Montgomery, it is now important that clinicians discuss all material risks (i.e. risks that a similar person in that particular patient’s position would attach significance to) with the Patient as part of the consent process. The risks need to be carefully explained to the patient in a way that they can understand as a layperson with no medical knowledge, and alternative treatment options should also be mentioned. Leaflets are still a good source of information; however, clinicians should go through the information contained in these and anything else that is relevant with the patient and document this process in their records.

2. Clinicians should consider carefully what risks a patient will likely attach significance to and should make sure that these are brought to the patient’s attention as part of the consent process.

When consenting a patient for a procedure, the clinician should consider what risks the particular patient would attach significance to and should then discuss these risks with the patient as part of the consent process. When considering what risks a patient would attach significance to, the clinician should consider what that particular patient, given their characteristics, would consider relevant. Factors to consider are the nature of the risk, the effect which its occurrence would have upon the life of the patient, the importance to the patient of the benefits sought to be achieved by the treatment, the alternatives available, and the risks involved in those alternatives. For example, as in this case there was a significant risk of a poor cosmetic outcome, the clinician should have discussed this with the Claimant as well as any alternative treatments that could be offered.

Conclusions

It is of vital importance that a discussion of the risks involved with a procedure takes place between the patient and the clinician as part of the consent process. Clinicians should document this discussion in the patients records.